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The 4 Steps to treating DM2 - •Step 1. At diagnosis, initiate lifestyle changes plus metformin.
•Step 2. Continue lifestyle changes plus metformin, and add a second drug, a thiazolidinedione, a
dipeptidyl peptidase-4 (DPP-4) inhibitor, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, a
glucagon-like peptide-1 (GLP-1) receptor agonist.
A sulfonylurea or basal insulin should be considered if the patient does not achieve goal with these
drugs. The choice of agent is made considering relative efficacy, hypoglycaemias risk, tolerability,
weight-related considerations, and cost.
•Step 3. Progress from step 2 to a three-drug combination (inclusive of metformin). Again, the choice
of regimen used is determined based on drug- and patient-specific considerations.
•Step 4. If three-drug combination therapy that includes basal insulin fails to achieve treatment goals
after 3-6 months, proceed to a combination injectable regimen inclusive of insulin and possible glp-1
receptor agonist.
3 rapid acting insulins - Lispro
Aspart
Glulisine
Peak time: 1-1.5hrs
Last 3-4 hrs
Rapid insulins do not LAG****
Short Acting Insulin - Regular (Humulin R, Novolin R)
Peak time: 2.5 hrs
Lasts: 4-6 hrs
, ***Regular and Short
Intermediate Acting Insulin - NPH (Humulin N, Novolin N)
Peak time: 8 hrs
Lasts: 10-16 hrs
**Not Particularly Hasty
Long Acting Insulins - Glargine & Detemir
Peak time: no peak time
Lasts: 24hrs
Give SQ once daily at bedtime
******** ******** 24 hours is a long time*****
(Take once per day)
Replaces basal functioning of a Type I's pancreas
.
A1C values -
DPP-4 inhibitors - Linagliptin, saxagliptin, sitagliptin
Enhances the actions of incretin hormones
Adverse: